甲状腺细针抽吸术 Bethesda 分类 III 级（意义不明确的不典型性/意义不明确的滤泡性病变）的甲状腺乳头状癌风险分层可通过肿瘤大小辅助精准治疗。
The Risk Stratification of Papillary Thyroid Cancer With Bethesda Category III (Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance) by Thyroid Fine-Needle Aspiration Could Be Assisted by Tumor Size for Precision Treatment.
机构信息
Shanghai Center of Thyroid Diseases, Shanghai, China.
Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
出版信息
Front Endocrinol (Lausanne). 2022 Feb 7;13:822423. doi: 10.3389/fendo.2022.822423. eCollection 2022.
PURPOSE
To investigate the clinical characteristics of papillary thyroid cancer (PTC) classified as Bethesda category III [atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS)] by fine-needle aspiration (FNA) for precision treatment.
METHODS
A total of 1,739 patients diagnosed with Bethesda category III (AUS/FLUS) by FNA were investigated, and 290 patients diagnosed with PTC were analyzed.
RESULTS
The rate of papillary thyroid microcarcinoma (PTMC) was 82.1% (238/290). The rates of lymph node metastases were 44.9% (22/49) and 25.2% (56/222) for PTC and PTMC, respectively (p = 0.006). The rates of extra-thyroid extension were 46.2% (24/52) and 19.8% (47/237) (p < 0.001). Compared with PTMC, PTC had significantly higher odds ratios (ORs) of 3.41 (1.81-6.44, p < 0.001), 2.19 (1.16-4.13, p = 0.016), and 2.51 (1.29-4.88, p = 0.007) for extra-thyroid extension, multifocality, and lymph node metastases, respectively, after adjustment for age and gender. The larger size and BRAF V600E mutation had a robust synergistic effect for invasive features. The rates of lymph node metastases, multifocality, and extra-thyroid extension were significantly increased with larger sizes harboring BRAF V600E mutation. Compared with PTMC harboring wild type (WT)-BRAF, PTC harboring BRAF V600E mutation had adjusted higher ORs of 3.01 (1.26-8.68, p = 0.015), 3.20 (1.22-8.42, p = 0.018), and 5.62 (2.25-14.01, p < 0.001) for lymph node metastases, multifocality, and extra-thyroid extension, respectively.
CONCLUSIONS
In this study, risk stratification was recommended for patients with Bethesda category III (AUS/FLUS) nodules with a size under 1 cm harboring WT-BRAF being regarded as low risk and should be recommended for active surveillance. Nodules with a size over 1 cm harboring WT-BRAF or those under 1 cm harboring BRAF V600E mutation could be regarded as moderate risk, and molecular testing should be recommended. However, those with a size over 1 cm harboring BRAF V600E mutation should be regarded as high risk, and a diagnostic surgery should be recommended.
目的
研究通过细针穿刺（FNA）诊断为 Bethesda 类别 III（不明确意义的滤泡性病变/不典型性）的甲状腺乳头状癌（PTC）的临床特征，以便进行精准治疗。
方法
对 1739 例通过 FNA 诊断为 Bethesda 类别 III（不明确意义的滤泡性病变/不典型性）的患者进行了研究，并对 290 例诊断为 PTC 的患者进行了分析。
结果
甲状腺微小乳头状癌（PTMC）的比例为 82.1%（238/290）。PTC 和 PTMC 的淋巴结转移率分别为 44.9%（22/49）和 25.2%（56/222）（p=0.006）。甲状腺外侵犯率分别为 46.2%（24/52）和 19.8%（47/237）（p<0.001）。与 PTMC 相比，PTC 的甲状腺外侵犯、多灶性和淋巴结转移的优势比（OR）分别显著升高，为 3.41（1.81-6.44，p<0.001）、2.19（1.16-4.13，p=0.016）和 2.51（1.29-4.88，p=0.007），这些差异在调整年龄和性别后仍然存在。较大的肿瘤大小和 BRAF V600E 突变对侵袭性特征具有强大的协同作用。携带 BRAF V600E 突变的肿瘤体积越大，淋巴结转移、多灶性和甲状腺外侵犯的发生率越高。与携带野生型（WT）-BRAF 的 PTMC 相比，携带 BRAF V600E 突变的 PTC 的淋巴结转移、多灶性和甲状腺外侵犯的调整后 OR 分别为 3.01（1.26-8.68，p=0.015）、3.20（1.22-8.42，p=0.018）和 5.62（2.25-14.01，p<0.001）。
结论
在这项研究中，建议对 Bethesda 类别 III（不明确意义的滤泡性病变/不典型性）结节进行风险分层，对于直径<1cm 且携带 WT-BRAF 的结节，建议进行积极监测。对于直径>1cm 且携带 WT-BRAF 或直径<1cm 且携带 BRAF V600E 突变的结节，建议进行分子检测。然而，对于直径>1cm 且携带 BRAF V600E 突变的结节，应视为高危，建议进行诊断性手术。
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